De novo metastatic breast cancer: Subgroup analysis of molecular subtypes and prognosis

Zhang,Li; Li,Zhijun; Zhang,Jie; Wu,Yansheng; Zhu,Yuying; Tong,Zhongsheng

doi:10.3892/ol.2020.11359

De novo metastatic breast cancer: Subgroup analysis of molecular subtypes and prognosis

Authors:
- Li Zhang
- Zhijun Li
- Jie Zhang
- Yansheng Wu
- Yuying Zhu
- Zhongsheng Tong
View Affiliations

Affiliations: Department of Breast Oncology, Key Laboratory of Breast Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, P.R. China, Department of Maxillofacial and Otorhinolaryngology, Head and Neck Surgery, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, P.R. China
Published online on: January 30, 2020 https://doi.org/10.3892/ol.2020.11359
Pages: 2884-2894
Copyright: © Zhang et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

The purpose of the present study was to analyze the clinical and pathological characteristics, treatment, and prognosis of de novo metastatic breast cancer (DnMBC). Information regarding 1,890 patients treated for advanced breast cancer at the Tianjin Medical University Cancer Hospital between January 2008 to December 2017 was collected. Clinicopathological characteristics, treatments and outcomes of these patients were compared using the chi‑square test, log‑rank test, and Cox regression analysis. A total of 171 patients were diagnosed with DnMBC. The median age at diagnosis was 53 years (range, 23‑77). The percentage of T4 staging was higher (37.4%), 69.6% of patients were estrogen receptor (ER) positive, 59.1% were progesterone receptor positive, 29.8% had positive human epidermal growth factor receptor 2 (HER2) status, 68.4% had Ki‑67 ≥20%, 55% had oligometastasis at the initial diagnosis, ~87.7% were treated with chemotherapy initially and 24% received palliative surgery for the primary tumor. After a median follow‑up time of 26 months, the median progression‑free survival (PFS) and overall survival (OS) among patients with DnMBC were 11 (8.7‑13.3) months and 34 (27.9‑40.1) months, respectively. In the multivariable model, ER status and sites of first metastasis (oligometastasis or polymetastasis) were identified to be independent predictors of PFS (P<0.05); ER status, primary tumor stage, and surgical treatment of primary tumors were identified to be independent predictors of OS (P<0.05). In conclusion, the clinicopathological characteristics of DnMBC are greater invasiveness and a higher risk of progression. Palliative surgical treatment may improve the prognosis of HR+/HER2‑patients with oligometastasis. Therefore, individualized treatment as required is particularly important.

View Figures

View References

1	Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA and Jemal A: Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 68:394–424. 2018. View Article : Google Scholar : PubMed/NCBI
2	Badwe R, Hawaldar R, Nair N, Kaushik R, Parmar V, Siddique S, Budrukkar A, Mittra I and Gupta S: Locoregional treatment versus no treatment of the primary tumour in metastatic breast cancer: An open-label randomised controlled trial. Lancet Oncol. 16:1380–1388. 2015. View Article : Google Scholar : PubMed/NCBI
3	Cardoso F, Spence D, Mertz S, Corneliussen-James D, Sabelko K, Gralow J, Cardoso MJ, Peccatori F, Paonessa D, Benares A, et al: Global analysis of advanced/metastatic breast cancer: Decade report (2005–2015). Breast. 39:131–138. 2018. View Article : Google Scholar : PubMed/NCBI
4	Dawood S, Broglio K, Gonzalez-Angulo AM, Buzdar AU, Hortobagyi GN and Giordano SH: Trends in survival over the past two decades among white and black patients with newly diagnosed stage IV breast cancer. J Clin Oncol. 26:4891–4898. 2008. View Article : Google Scholar : PubMed/NCBI
5	Malmgren JA, Mayer M, Atwood MK and Kaplan HG: Differential presentation and survival of de novo and recurrent metastatic breast cancer over time: 1990–2010. Breast Cancer Res Treat. 167:579–590. 2018. View Article : Google Scholar : PubMed/NCBI
6	Cortesi L, Toss A, Cirilli C, Marcheselli L, Braghiroli B, Sebastiani F and Federico M: Twenty-years experience with de novo metastatic breast cancer. Int J Cancer. 137:1417–1426. 2015. View Article : Google Scholar : PubMed/NCBI
7	Andre F, Slimane K, Bachelot T, Dunant A, Namer M, Barrelier A, Kabbaj O, Spano JP, Marsiglia H, Rouzier R, et al: Breast cancer with synchronous metastases: Trends in survival during a 14-year period. J Clin Oncol. 22:3302–3308. 2004. View Article : Google Scholar : PubMed/NCBI
8	Cortesi L, Cirilli C, Rashid I, Artioli E and Federico M: Changes in survival from metastatic breast cancer during the last twenty-years: A population based study in Northern Italy. J Clin Oncol. 27:11252009.
9	Lobbezoo DJ, van Kampen RJ, Voogd AC, Dercksen MW, van den Berkmortel F, Smilde TJ, van de Wouw AJ, Peters FP, van Riel JM, Peters NA, et al: Prognosis of metastatic breast cancer subtypes: The hormone receptor/HER2-positive subtype is associated with the most favorable outcome. Breast Cancer Res Treat. 141:507–514. 2013. View Article : Google Scholar : PubMed/NCBI
10	Hammond ME, Hayes DF, Dowsett M, Allred DC, Hagerty KL, Badve S, Fitzgibbons PL, Francis G, Goldstein NS, Hayes M, et al: American society of clinical oncology/college of American pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer (unabridged version). Arch Pathol Lab Med. 134:e48–e72. 2010.PubMed/NCBI
11	Liu F, Lang R, Wei J, Fan Y, Cui L, Gu F, Guo X, Pringle GA, Zhang X and Fu L: Increased expression of SDF-1/CXCR4 is associated with lymph node metastasis of invasive micropapillary carcinoma of the breast. Histopathology. 54:741–750. 2009. View Article : Google Scholar : PubMed/NCBI
12	Cui LF, Guo XJ, Wei J, Liu FF, Fan Y, Lang RG, Gu F, Zhang XM and Fu L: Overexpression of TNF-alpha and TNFRII in invasive micropapillary carcinoma of the breast: Clinicopathological correlations. Histopathology. 53:381–388. 2008. View Article : Google Scholar : PubMed/NCBI
13	Qian XL, Wen HY, Yang YL, Gu F, Guo XJ, Liu FF, Zhang L, Zhang XM and Fu L: Assessment of dual-probe Her-2 fluorescent in situ hybridization in breast cancer by the 2013 ASCO/CAP guidelines produces more equivocal results than that by the 2007 ASCO/CAP guidelines. Breast Cancer Res Treat. 159:31–39. 2016. View Article : Google Scholar : PubMed/NCBI
14	Chen L, Romond E, Chokshi S, Saeed H, Hodskins J, Stevens M, Pasley G, Weiss H and Massarweh S: A prognostic model of early breast cancer relapse after standard adjuvant therapy and comparison with metastatic disease on initial presentation. Breast Cancer Res Treat. 136:565–572. 2012. View Article : Google Scholar : PubMed/NCBI
15	Dawood S, Broglio K, Ensor J, Hortobagyi GN and Giordano SH: Survival differences among women with de novo stage IV and relapsed breast cancer. Ann Oncol. 21:2169–2174. 2010. View Article : Google Scholar : PubMed/NCBI
16	Vaz-Luis I, Lin NU, Keating NL, Barry WT, Lii H, Winer EP and Freedman RA: Racial differences in outcomes for patients with metastatic breast cancer by disease subtype. Breast Cancer Res Treat. 151:697–707. 2015. View Article : Google Scholar : PubMed/NCBI
17	Lee ES, Jung SY, Kim JY, Kim JJ, Yoo TK, Kim YG, Lee KS, Lee ES, Kim EK, Min JW, et al: Identifying the potential long-term survivors among breast cancer patients with distant metastasis. Ann Oncol. 27:828–833. 2016. View Article : Google Scholar : PubMed/NCBI
18	den Brok WD, Speers CH, Gondara L, Baxter E, Tyldesley SK and Lohrisch CA: Survival with metastatic breast cancer based on initial presentation, de novo versus relapsed. Breast Cancer Res Treat. 161:549–556. 2017. View Article : Google Scholar : PubMed/NCBI
19	Soran A, Ozmen V, Ozbas S, Karanlik H, Muslumanoglu M, Igci A, Canturk Z, Utkan Z, Ozaslan C, Evrensel T, et al: A randomized controlled trial evaluating resection of the primary breast tumor in women presenting with de novo stage IV breast cancer: Turkish Study (Protocol MF07-01). J Clin Oncol. 34:10052016. View Article : Google Scholar
20	Thomas A, Khan SA, Chrischilles EA and Schroeder MC: Initial surgery and survival in stage IV breast cancer in the United States, 1988–2011. JAMA Surg. 151:424–431. 2016. View Article : Google Scholar : PubMed/NCBI
21	Lambertini M, Ferreira AR, Di Meglio A, Poggio F, Puglisi F, Sottotetti F, Montemurro F, Poletto E, Bernardo A, Risi E, et al: Patterns of care and clinical outcomes of HER2-positive metastatic breast cancer patients with newly diagnosed stage IV or recurrent disease undergoing first-line trastuzumab-based therapy: A multicenter retrospective cohort study. Clin Breast Cancer. 17:601–610.e2. 2017. View Article : Google Scholar : PubMed/NCBI
22	Badwe R, Parmar V, Hawaldar R, Nair N, Kaushik R, Siddique S, Navale A, Budrukkar A, Mittra I and Gupta S: Surgical removal of primary tumor and axillary lymph nodes in women with metastatic breast cancer at first presentation: A randomized controlled trial. Cancer Res. 73 (24 Suppl):S2–02. 2013.
23	King TA, Lyman J, Gonen M, Voci A, De Brot M, Boafo C, Sing AP, Hwang ES, Alvarado MD, Liu MC, et al: A prospective analysis of surgery and survival in stage IV breast cancer: TBCRC 013. J Clin Oncol. 34:2359–2365. 2016. View Article : Google Scholar : PubMed/NCBI
24	Molnár IA, Molnár BÁ, Vízkeleti L, Fekete K, Tamás J, Deák P, Szundi C, Székely B, Moldvay J, Vári-Kakas S, et al: Breast carcinoma subtypes show different patterns of metastatic behavior. Virchows Arch. 470:275–283. 2017. View Article : Google Scholar : PubMed/NCBI
25	Lobbezoo DJ, van Kampen RJ, Voogd AC, Dercksen MW, van den Berkmortel F, Smilde TJ, van de Wouw AJ, Peters FP, van Riel JM, Peters NA, et al: Prognosis of metastatic breast cancer: Are there differences between patients with de novo and recurrent metastatic breast cancer. Br J Cancer. 112:1445–1451. 2015. View Article : Google Scholar : PubMed/NCBI
26	Savci-Heijink CD, Halfwerk H, Hooijer GK, Horlings HM, Wesseling J and van de Vijver MJ: Retrospective analysis of metastatic behaviour of breast cancer subtypes. Breast Cancer Res Treat. 150:547–557. 2015. View Article : Google Scholar : PubMed/NCBI
27	Tao L, Chu L, Wang LI, Moy L, Brammer M, Song C, Green M, Kurian AW, Gomez SL and Clarke CA: Occurrence and outcome of de novo metastatic breast cancer by subtype in a large, diverse population. Cancer Causes Control. 27:1127–1138. 2016. View Article : Google Scholar : PubMed/NCBI
28	Vaz-Luis I, Lin NU, Keating NL, Barry WT, Winer EP and Freedman RA: Factors associated with early mortality among patients with de novo metastatic breast cancer: A population-based study. Oncologist. 22:386–393. 2017. View Article : Google Scholar : PubMed/NCBI
29	Wang H, Zhang C, Zhang J, Kong L, Zhu H and Yu J: The prognosis analysis of different metastasis pattern in patients with different breast cancer subtypes: A SEER based study. Oncotarget. 8:26368–26379. 2017.PubMed/NCBI
30	Wu SG, Li H, Tang LY, Sun JY, Zhang WW, Li FY, Chen YX and He ZY: The effect of distant metastases sites on survival in de novo stage-IV breast cancer: A SEER database analysis. Tumour Biol. 39:10104283177050822017. View Article : Google Scholar : PubMed/NCBI
31	Hellman S and Weichselbaum RR: Oligometastases. J Clin Oncol. 13:8–10. 1995. View Article : Google Scholar : PubMed/NCBI
32	Weichselbaum RR and Hellman S: Oligometastases revisited. Nat Rev Clin Oncol. 8:378–382. 2011. View Article : Google Scholar : PubMed/NCBI
33	Milano MT, Katz AW, Schell MC, Philip A and Okunieff P: Descriptive analysis of oligometastatic lesions treated with curative-intent stereotactic body radiotherapy. Int J Radiat Oncol Biol Phys. 72:1516–1522. 2008. View Article : Google Scholar : PubMed/NCBI
34	Kobayashi T, Ichiba T, Sakuyama T, Arakawa Y, Nagasaki E, Aiba K, Nogi H, Kawase K, Takeyama H, Toriumi Y, et al: Possible clinical cure of metastatic breast cancer: Lessons from our 30-year experience with oligometastatic breast cancer patients and literature review. Breast Cancer. 19:218–237. 2012. View Article : Google Scholar : PubMed/NCBI
35	Wong AC, Watson SP, Pitroda SP, Son CH, Das LC, Stack ME, Uppal A, Oshima G, Khodarev NN, Salama JK, et al: Clinical and molecular markers of long-term survival after oligometastasis-directed stereotactic body radiotherapy (SBRT). Cancer. 122:2242–2250. 2016. View Article : Google Scholar : PubMed/NCBI